Healthcare Provider Details

I. General information

NPI: 1467959049
Provider Name (Legal Business Name): JOSEPH CARBONE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 RICHMOND RD
STATEN ISLAND NY
10306-2583
US

IV. Provider business mailing address

2052 RICHMOND RD
STATEN ISLAND NY
10306-2583
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-2190
  • Fax:
Mailing address:
  • Phone: 718-667-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX012959
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: